Prostate Cancer Treatment

One Size Doesn’t Fit All

Active, involved and optimistic, 76-year-old Bruce Burdick enjoys life. Since wrapping up a long career as an industrial designer in the San Francisco Bay area, he’s had no trouble filling his days. When diagnosed with prostate cancer in November of 2009, he decided to take a proactive approach to the disease by undergoing treatment.

“I wanted my healthy lifestyle to continue for many years to come. I went down the decision tree after I received my diagnosis,” said Mr. Burdick. “I did my homework and carefully weighed all of the options with my wife and doctor.”

Exploring the Pros and Cons

Men diagnosed with localized prostate cancer have more treatment options than ever before. If the disease is caught at an early stage, it is highly curable. But treatment decisions are not always easy for patients or their doctors. Some prostate cancers grow so slowly they will never cause problems during a man’s lifetime. Other tumors are fast-growing and potentially lethal. While early detection and proper care can save lives, aggressive treatment can come with a price. Surgical removal or radiation of the prostate can cause temporary or permanent erectile dysfunction and incontinence in varying degrees.

“We have to weigh the danger posed by the cancer with the potential harms of treatment,” said CPMC urologist Rodman Rogers, M.D. “Every treatment has to be individualized.”

Digital rectal exams and prostate-specific antigen (PSA) blood tests are used to spot the signs of prostate cancer. Only a biopsy can confirm a diagnosis. To predict prognosis and guide therapy decisions, doctors determine the grade and stage of the cancer. This is done by examining cells from the tumor under a microscope.

“For men with less aggressive, low grade forms of the disease, watchful waiting or active surveillance can be a viable option – meaning the cancer is closely monitored and treatment is postponed until there is evidence the disease is growing,” said Dr. Rogers.

Radiation Therapy

Watchful waiting wasn’t an appealing option for Mr. Burdick. His doctors felt he had a good chance of recovery with high dose rate brachytherapy, a form of internal radiation therapy that can kill cancer cells and shrink tumors while reducing the risk of damage to nearby healthy tissue. In addition to prostate cancer, brachytherapy is commonly used as an effective treatment for cancers of the head, neck, breast, uterus, cervix, gall bladder, esophagus, eye and lung.

“Older men who have localized prostate cancer or cancer just immediately outside the gland are good candidates for this type of treatment,” explained John Lee, M.D., Mr. Burdick’s radiation oncologist at CPMC. “Because it is minimally invasive, it can offer the patient a short recovery time.”

In January of 2010, Mr. Burdick underwent the procedure at CPMC. A cancer team administered a series of radiation treatments through tiny plastic catheters placed into his prostate gland. After a 36-hour hospital stay, he was home. The treatment was repeated two weeks later.

“Because I had read so much about it, I knew what to expect. Still, I feared the pain and felt apprehensive about the whole thing,” he said. “Thankfully, none of my fears were realized.”

A few days after the procedure, Mr. Burdick was mildly sore but back to his normal activities. “My symptoms have since improved,” he said. “It took about three months for my system to come online again.”

Surgical Treatment

Radical prostatectomy, an operation that removes the walnut-sized prostate gland and surrounding tissues, is a common treatment option for men with localized cancer.

“The main advantage of surgery is that it offers the most definitive treatment,” said Dr. Rogers. “In some patients, it lowers the risk that the cancer will grow or spread.”

Open surgeries and laparoscopic procedures are commonly performed. Robotic-assisted radical prostatectomy is rapidly being chosen by more men as well as their physicians, including Dr. Rogers.

“The robotic-assisted surgical system we use can produce smaller incisions and less blood loss. It can also result in less pain for the patient and shorter stays in the hospital,” said Dr. Rogers. “In most cases, it can help our patients get back to their usual life more quickly.”

After being diagnosed with localized prostate cancer, Akiyoshi Kuwada had robotic-assisted surgery at CPMC.

“I had always been healthy prior to the diagnosis. I didn’t want to deal with the possibility of my cancer spreading,” he said. “I was in my mid-60s at the time and wanted the disease gone so I could go on with my life.”

Mr. Kuwada had a radical prostatectomy in June of 2008. He spent three days in the hospital. His wife of 40 years helped him through the healing process at home. Recovery took about three months. Now cancer-free, Mr. Kuwada is coaching high school basketball again, and looking forward to living a long life.

The Road to Recovery

Mr. Burdick is also on the road to recovery – with peace of mind. “No one would ever volunteer for the experience I endured, but I am pleased with the choice I made,” he said.

After his ordeal, he has advice for men who may one day walk in his shoes. “Research your options before you sit down to have a conversation with your doctor,” he suggested. “Be sure you know all of your options and the potential outcomes of each.”

Prostate Cancer Facts

- Strikes one out of every six men- Second leading cause of cancer death in American men- An estimated 217,730 new cases will be diagnosed in 2010